When Parents Say No to Child Vaccinations

By DONALD G. McNEIL Jr.

Published: November 30, 2002

VASHON ISLAND, Wash.—
Kate Packard, the school nurse here, has a nightmare she sums up in five words: ''measles coming across the water.''

If measles did make the 20-minute ferry ride across Puget Sound from Seattle -- hardly unthinkable, since a case occurred last year near a ferry terminal in West Seattle -- public health officers say the whole Vashon Island school district could be shut down until the island's last case disappeared or an emergency vaccination drive took effect.

Eighteen percent of Vashon Island's 1,600 primary school students have legally opted out of vaccination against childhood diseases, including polio, measles, mumps, rubella, diphtheria, whooping cough, tetanus, hepatitis B and chicken pox. The island is a counterculture haven where therapies like homeopathy and acupuncture are popular, and where some cite health problems among neighbors' children that they attribute to vaccinations.

Most families opting out of vaccination here have obtained ''philosophical exemptions'' from normal vaccination requirements -- exemptions that in Washington and several other states, including California and Colorado, can be claimed simply by signing a school form.

Across the country, about 1 percent of all children are exempt from vaccination, said Dr. Walter A. Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention. The agency's surveys suggest that more than 90 percent of all American children have had most shots, except for the new chicken-pox vaccine.

But from Vashon Island to Boulder, Colo., to towns in Missouri and Massachusetts, there are ''hot spots'' where many children go unprotected. In a 1999 survey, 11 states reported increases in exemptions.

Clusters of unvaccinated children are not only in potential danger themselves, health officials say, but are also a threat to the ''herd immunity'' that walls out epidemics, sheltering fetuses, infants too young to be immunized, old people with weakened immune systems and even vaccinated classmates who remain at risk because no vaccine is 100 percent effective.

When only a few parents use ''herd immunity'' to let their children escape the small risks of vaccination, the system still works.

But health officials become concerned in states like California, where it is easier for a parent to sign the waiver form than to have a child vaccinated. ''People take the path of least resistance,'' said Daniel A. Salmon, a vaccination expert at the Johns Hopkins School of Public Health. ''What I do to my child can put other children at risk.'' In 1989-90, measles broke out among unimmunized immigrant children in Southern California, causing 43,000 cases and 101 deaths.

Vaccine resisters cite an array of reasons. ''Sometimes it's distrust in government, feeling it's in bed with the vaccine industry and 'everyone's making money off our kids,' '' Mr. Salmon said. Sometimes the objections are religious, as among Christian Scientists and some Amish congregations. Sometimes a community is scared when a child is truly harmed by side effects; the live polio vaccine, for example, is thought to cause about eight deaths a year.

Some parents are upset at the sheer number of injections a child must get -- usually about 20 by age 2. Others are convinced -- despite evidence to the contrary -- that vaccines are highly likely to cause severe health problems, like seizures and autism.

Here on Vashon Island, a community of 10,000, word spread quickly when the 10-month-old baby of Gail O'Grady, a midwife who also works at Minglement Natural Foods, died unexpectedly in his crib in 1984 two weeks after his first immunization; when Pam Beck's daughter Rachel suffered four years of seizures that began minutes after her first whooping-cough shot; when Nancy Soriano's son, Alex, developed autism after tetanus and polio vaccinations.

Some doctors they consulted disagreed, but all three mothers were sure vaccines were to blame.

Alex, Ms. Soriano said, changed from ''a bright-eyed, happy, beautiful kid'' to a severely autistic 4-year-old who ''lived curled up in a ball, screaming and screaming and screaming.'' She says she has nearly cured him by removing milk and glutens from his diet.

Public health specialists suggest that the resistance to vaccines is a consequence of the success of vaccinations: People, they say, no longer fear diseases they have never seen.

''I remember how the fear of polio changed our lives -- not going to the swimming pool in summer, not going to the movies, not getting involved with crowds,'' said Dr. Edward P. Rothstein, 60, a Pennsylvania pediatrician who helps the American Academy of Pediatrics make immunization recommendations. ''I remember pictures of wards full of iron lungs, hundreds in a room, with kids who couldn't breathe in them. It affected daily life more than AIDS does today.''

Now, with the rare side effects of the live vaccine, ''there's a risk of about eight kids a year dying, so people don't want to be vaccinated,'' he said, adding, ''When polio was around, people gladly took that risk.''